Sunday, October 14, 2012

Autism Stem Cell Treatment Research: Who is the Real Quack? Gorski (ORAC) or the FDA?

Real Quackery: Duck Flapping and Splashing  
Photos by HLDoherty 

In any commentary in which I dare question the self appointed protector of all things scientific, the ORACle known as Dr. David H. Gorski,  I have to begin with the statement that I recognize the public health importance of vaccines and that both of my sons, and I for that matter, have received all vaccines recommended by our local public health authorities in New Brunswick.  This statement is necessary because Dr. Gorski almost invariably alleges that anyone who questions the wisdom he brings down from the mountain top for us, the ignorant unwashed, is really just a closet anti-vaxxer.  I don't think vaccines are perfect though and it is my understanding that neurological damage has been caused by some vaccines in some individuals. I am aware also that Dr. Bernadine Healey had recommended further study of possible vaccine autism connections before her death ... and that some had vilified her for doing so.

Yesterday I commented on the fact that the FDA had approved a study to determine whether umbilical cord blood derived stem cells might be effective tools in treating autism. The article I quoted from contains some professional quotes indicating that the study is well designed and also contained a number of quotes expressly indicating that it is a very PRELIMINARY study.  I was happy to see research aimed at establishing or assessing possible treatments for autism disorders.  I was also happy that the study was, as reported in the article, approved by the US FDA.  To my thinking, as a humble autism dad,  FDA approval confirmed that the study would be conducted by appropriate guidelines, professionally and ethically. My commentary attracted a comment from MJ, author of the Autism Jabberwocky blog:

"Did you notice that the self-appointed high priest of science wrote (at least) two pieces on stem cells and autism? In the first he calls it quackery because it isn't evidence based and in the second says that studying the issue at all is unethical. He really seems to want to have it both ways. No treatments without proper research, which is reasonable, but no research because there is no evidence that it would work...."

I think MJ has made an excellent point.  How are we supposed to determine what is evidence based, effective treatment for autism or any other disorder, if no research is done to determine effectiveness?

Gorski`s objection to the ethics of a preliminary study of stem cells in treating autism disorders is set out in Is a trial of stem cell therapy in autism scientifically and ethically justified? :

``Think of it this way: Do you think that the evidence implicating a hyperactive immune system is strong enough to justify treating autistic children with prednisone? Cyclosporine? Other immunosuppressive drugs? If not, then why would anyone advocate using autologous stem cells, which appear to be immunosuppressive? Why on earth would an institute like the Sutter Neuroscience Institute carry out such a trial based on low prior probability? What sort of preclinical evidence did they have to justify this trial? The scientists in the article who say that the likelihood of a positive result from this trial is low are, if anything, too optimistic. The likelihood of a positive result is almost homeopathically low. When it comes to clinical equipoise, this trial looks to me as though it’s all risk with too little prospect of benefit to be justifiable without a lot more clinical evidence.``

While he is notorious for splashing for attention by flapping his wings and quacking out cheap insults at those who disagree with him, I have no doubt that surgical oncologist Dr. David H. Gorski (ORAC) is much better placed than I am to assess the ethical basis for conducting this preliminary study.   He questions the internal review board (IRB), apparently unknown to him at the time, in  a reasonably courteous, serious  manner.  What is not really clear from Gorski's comments is whether he would ever view any autism treatment study as justifying  supervision by an IRB or approval by the FDA.  In the comment linked above he did state with reference to pharmaceutical companies seeking drug approval:

"Similarly, any private entity (such as a pharmaceutical company) seeking FDA approval for its drug or device have to register with the FDA and abide by the Common Rule, whose most important set of rules mandate IRB approval and monitoring of the research. Some states also mandate that all human subjects research carried out within their borders, regardless of funding source, must abide by the Common Rule."

Since there is an IRB in place for this preliminary study, and since the FDA has given its approval for it to proceed, I assume Dr. Gorski (ORAC) will, if he has not already done so, acknowledge that this study is being conducted in accordance with recognized public health authority backing. As a mere layperson I assume that the US FDA has conducted the usual inquiries and that they are best placed, even better placed than surgical oncologist and autism expert Dr. Gorski, to determine the ethical appropriateness of the study. 

I assume that Dr. Gorski who feels FDA approval is a comforting requirement for  approval of new pharmaceutical company drugs or devices is also comforted by the FDA approval of the stem cell preliminary study. Surely he does not now consider the FDA to be governed by the quacks he so detests?

Regardless, if Gorski, the FDA or any other health professional or authority is simply going to ridicule and dismiss attempts to conduct any research into possible autism treatments and cures they will simply lose credibility with many autism parents when they try to convince them that they should stick with evidence based treatments for their autistic children.  That is not quackery. That is reality.


M.J. said...

"autism expert Dr. Gorski"

Heh, now that is a funny description of Gorski. He doesn't seem like an autism expert from the bits of his writing that I have read. Although he certainly does enjoy playing one on the internet.

I think his objections to even looking at stem cells for treating autism comes from the possible involvement of the immune system. If stem cells help the symptoms of autism that would mean that immune system disruptions play a major role in causing and sustaining the symptoms of autism. And if that is the case then that could implicate anything that has the potential to disrupt the immune system.

Although, unfortunately for Gorski's theory, there is quite a substantial body of evidence that suggests that the immune system is very involved in autism. There might not be a smoking gun that shows a direct causative path from immune system disruptions to the symptoms of autism but there are many documented disruptions that have the potential to alter neural development as well as cause other biological problems that are observed in autism. There are even studies that suggest that there is a relationship between the severity of the immune disruption and the severity of the symptoms of autism.

Besides which, a causal relationship isn't the standard that is required to try a small scale trial. If that was the standard then there shouldn't be any trials of anything for treating autism because we still have no clue what autism is let alone what causes it. I don't understand how you are can have causative biological evidence when you can't even define what something is on biological level.

No, I think the real problem is that Gorksi is scared that the idea that the link between the immune system is real and that by re-regulating the immune system you might be able to mitigate the symptoms of autism. I don't think his ego would be able to take it.

Unknown said...

"autism expert Dr. Gorski"

Yeah, my Inherent Sarcasm Disorder got the better of me on that one. Amazing that the surgical oncologist figures he has a better handle on autism disorders than his professional colleagues who actually who actually work with and study autism and autistic children and adults.

Unknown said...

I'm just totally amazed!! If there are any possiblties so it is the excellent news about Autism disorder.But i want to ask you what about the some research in place? What about new techniques like steam cells, new drugs, genetic engineering? What about alternative medicine?
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Roger Kulp said...

Hi Harold,

I have not read your blog in ages.I like Gorski's blogs,but have to say you both have a valid point.Gorski is a cancer surgeon and sometime researcher.Both cancer and autism involve desperate families looking for answers.Gorski has said over and over again that he requires proof that something is real,that can be proven over and over again.

As you recall,I have a diagnosis somewhere in between Asperger's and classic autism,a lot of developmental problems as a child,a lot of medical issues,both immune and metabolic.Problems that have triggered multiple regressions over the years.

Like a lot of people born before the DSM-IV,I was officially diagnosed as autistic as an adult,but I had many other developmental and psychiatric diagnoses as a child.

I am not ashamed to say that I have been seen by a DAN! doctor since 2008.I have had a ridiculous amount of tests over the last four years,a lot of which I have requested.Early on,we found I had serious problems with both folate and B12 metabolism.Problems that could only be genetic.I have been on increasingly higher doses of leucovorin since.My autism,and related brain issues have improved dramatically.So much that it kept me out of a group home,when my mother died in April.My regressions,and seizures went away,and for the first time in my life,I am free of acute infections.

Two weeks ago,I was officially diagnosed with that new form of cerebral folate deficiency that has been the talk of the autism community.I have both of the autoantibodies.I am one of those who does not have mitochondrial disease,but instead has a different metabolic disease,methylmalonic acidemia and homocystinuria.Something the DAN! doctor found early on.

I was diagnosed through an experimental program at SUNY Downstate Medical Center.Now we need to figure out what kind of immune problems I have.

This is a disease that is both metabolic and immune.It is not like anything known to science before.

There is not a lot about cerebral folate deficiency out there,it was only discovered about 2004.One study I have found,is this one from Spain..It's behind a paywall,but you can read the graphs and charts.

Look at the lower left hand corner of figure three.It says hypogammaglobulinemia..There is quite a range for this disease.Read what it says at my link under vaccines in the "workup" section.Like the seizures in Dravet Syndrome,another cause of autism,a natural infection can trigger the immune disease,and I suspect the autism,if there is cerebral folate deficiency as well.I had acute meningitis when I was six months old.I suspect this did it for me.

So everybody is right here.It is genetic or inborn,and vaccines can be a trigger.I suspect like mitochondrial disease,this will be one of those things people will say causes "features of autism",but not autism.Fine with me.

But if I had a child who had no medical issues,and had true classic autism,this would not be the first place I would look.I would start by seeing if there were a history of Alzheimer's and Parkinson's in my family,and look into the work done at SUNY Upstate on that particular type of autism.

Unknown said...

Hey Roger. Thanks for your comment. Good to hear from you again. Harold

Dona Kemmer said...

Stem cell therapy has been hotly contested in the press, with many religious groups claiming that their usage is unethical and wrong. The claim is that only God should be able to create life, and that creating and using stem cells is an abomination since the cells are extracted from undeveloped human fetuses. However, stem cell usage is not quite as cut and dried as these groups like to believe. The truth is that there are a lot of potential benefits when it comes to using stem cells, and these could have big implications in medical fields.

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